CT Arthrography

A special issue of Tomography (ISSN 2379-139X).

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 4779

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Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37042 Verona, Italy
Interests: MSK imaging; CT; DECT; MRI; shoulder; hip; adrenal; liver; pancreas; lung; infectious diseases; endometriosis
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Dear Colleagues,

By distending the articular cavity with the injection of diluted contrast material, arthrography allows for the identification and fine evaluation of small anatomic structures located inside the articular cavity. Magnetic resonance arthrography (MRA) has been widely used in the past because of its intrinsic high contrast resolution.

However, MRI is a relatively long and expensive procedure that is not always suitable because of absolute or relative contraindications. In addition, MRA image quality could be altered by metal artifacts, often affecting previously operated articulations.

In comparison, computed tomography arthrography (CTA) is a cheaper and faster exam that is virtually free from motion artifacts. CT allows us to obtain high-resolution images for the evaluation of bony structures. Moreover, with the advent of modern scanners, radiation burden does not represent a problem in the adult population.

Computed tomography arthrography (CTA) has been successfully used for diagnosing glenohumeral joint cartilages, labral lesions, and rotator cuff tears. In particular, CTA of the shoulder can be considered comparable with regards to the identification of superior labrum lesions and full-thickness rotator cuff tears and represents a more reliable imaging tool for the evaluation of glenoid rim fractures and inferior glenohumeral ligament injuries. Moreover, CTA is a powerful tool for the evaluation of operated shoulders. Additionally, in the case of shoulder dislocation, CT allows the assessment of glenoid bone loss.

In the hip, CTA has been proposed for the diagnosis of labrum and cartilage lesions. Thanks to isotropic images and high spatial resolution, CTA can be used to identify subtle cartilage defects in the femoral head or the acetabular roof. Finally, CTA is accurate in depicting intra-articular loose bodies and for the measurement of femoral and acetabular angles.

In the knee, CTA can be used to diagnose subtle menisci rupture and dissection OCLs.

In the wrist, ankle, and elbow, CTA can be proposed because of its high spatial resolution.

Moreover, dual-energy CT (DECT) has recently been proposed in musculoskeletal imaging to increase tissue contrast and reduce metal artifacts; potential advantages in CTA are the use of virtual non-calcium images for the detection of bone marrow edema, or the use of monoenergetic images for image contrast optimization and metal artifact reduction. Additionally, virtual non-contrast images can be used to remove contrast material to focus on the assessment of bony structures.

For these reasons, dual-energy CTA could increase the overall diagnostic accuracy with respect to standard CTA.

Dr. Giovanni Foti
Guest Editor

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Keywords

  • arthrography
  • computed tomography
  • cone beam
  • dual energy
  • shoulder
  • elbow
  • wrist
  • hip
  • knee
  • ankle
  • osteo-chondral lesions
  • dislocation
  • SLAP
  • bankart
  • FAI (femoro-acetabular impingement)
  • cartilage
  • menisci
  • Triangular Fibrocartilage Complex Injury (TFCC)
  • loose bodies

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Published Papers (2 papers)

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Review

13 pages, 5245 KiB  
Review
CT Arthrography of the Elbow: What Radiologists Should Know
by Gianluca Folco, Carmelo Messina, Salvatore Gitto, Stefano Fusco, Francesca Serpi, Andrea Zagarella, Mauro Battista Gallazzi, Paolo Arrigoni, Alberto Aliprandi, Marco Porta, Paolo Vitali, Luca Maria Sconfienza and Domenico Albano
Tomography 2024, 10(3), 415-427; https://doi.org/10.3390/tomography10030032 - 11 Mar 2024
Cited by 1 | Viewed by 2292
Abstract
Computed tomography (CT) arthrography is a quickly available imaging modality to investigate elbow disorders. Its excellent spatial resolution enables the detection of subtle pathologic changes of intra-articular structures, which makes this technique extremely valuable in a joint with very tiny chondral layers and [...] Read more.
Computed tomography (CT) arthrography is a quickly available imaging modality to investigate elbow disorders. Its excellent spatial resolution enables the detection of subtle pathologic changes of intra-articular structures, which makes this technique extremely valuable in a joint with very tiny chondral layers and complex anatomy of articular capsule and ligaments. Radiation exposure has been widely decreased with the novel CT scanners, thereby increasing the indications of this examination. The main applications of CT arthrography of the elbow are the evaluation of capsule, ligaments, and osteochondral lesions in both the settings of acute trauma, degenerative changes, and chronic injury due to repeated microtrauma and overuse. In this review, we discuss the normal anatomic findings, technical tips for injection and image acquisition, and pathologic findings that can be encountered in CT arthrography of the elbow, shedding light on its role in the diagnosis and management of different orthopedic conditions. We aspire to offer a roadmap for the integration of elbow CT arthrography into routine clinical practice, fostering improved patient outcomes and a deeper understanding of elbow pathologies. Full article
(This article belongs to the Special Issue CT Arthrography)
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14 pages, 5717 KiB  
Review
Dual-Energy CT Arthrography: Advanced Muscolo-Skelatal Applications in Clinical Practice
by Giovanni Foti, Christian Booz, Giuseppe Mauro Buculo, Eugenio Oliboni, Chiara Longo, Paolo Avanzi, Antonio Campacci and Claudio Zorzi
Tomography 2023, 9(4), 1471-1484; https://doi.org/10.3390/tomography9040117 - 8 Aug 2023
Cited by 1 | Viewed by 1916
Abstract
This paper provides a comprehensive overview of the potential applications of dual-energy CT (DECT) in improving image quality and the diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non-contrast (VNC) images, in which the injected [...] Read more.
This paper provides a comprehensive overview of the potential applications of dual-energy CT (DECT) in improving image quality and the diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non-contrast (VNC) images, in which the injected contrast medium is subtracted from the articular cavity in order to better analyze 2D and 3D images of the bone. Moreover, virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non-calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore, the role of iodine maps in enhancing the contrast between soft tissues, optimizing the visualization of contrast material, and distinguishing contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high-spatial-resolution dual-energy CT reconstructed images. Full article
(This article belongs to the Special Issue CT Arthrography)
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